Revenue Integrity Specialist

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 10%

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WVU Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

📋 Description

• Reviews charge review, claim, and denial edits for compliance with CCI, OCE, MUE claim edits and LCD & NCD billing rules while maximizing reimbursement • Supports development, testing, implementation, maintenance, and operational optimization of Epic’s Revenue Guardian module and related claim editing software • Monitors billing edit trends to identify retraining and editing-tool optimization needs • Communicates training and optimization needs to clinical leadership, chargemaster committee, compliance, and related areas • Manages payor and claim CCI, OCE, MUE, LCD and NCD edits accurately and compliantly • Tracks edited accounts, correspondence, actions, outcomes, coordination, and follow-up for payor and claim edits • Reports edit and denial appeal trends and activities to Revenue Cycle Leadership • Assists departments with compliance regarding government regulations related to claim edits • Works with revenue cycle leadership, chargemaster committee, and clinical departments to ensure optimal charge capture • Maintains current knowledge of payer policies and government regulations and communicates relevant information to leadership • Performs root-cause analysis for high-volume edits and works with Epic technical teams, clinical departments, and HIM to correct errors and missed charges • Reports claim-edit volumes and identifies new claim errors from updated policies • Performs claims reviews to ensure documentation supports captured charges • Supports Revenue Cycle Leadership and prioritizes work to reduce edit volume and meet payer appeal deadlines

🎯 Requirements

• High School Diploma or equivalent • Two (2) years of billing- revenue cycle experience • Must be capable of using computers effectively • Knowledge of medical terminology, ICD-10, CPT & HCPCS codes • Analytical, critical thinking and clear, concise communication skills are required to interact effectively with all levels of management • Must be capable of using copier/fax effectively • Good analytical skills including the use of Microsoft Excel and reporting tools • Good communication skills and professional demeanor required • Understanding of payor clinical reimbursement policies and government regulations • Understanding of ACP/MPFS payment structures and other third-party payment methodologies • Frequent walking, standing, stooping, kneeling, pushing, lifting, grasping, and feeling are necessary body movements utilized in performing duties through the work shift • Must be able to sit for extended periods of time • Must have reading and comprehension ability • Preferred: Bachelor’s degree in business or other healthcare related field or Health Information Technology graduate